Objective To explore the risk management factors and preventive measures in obstetric care. Methods The implementation of risk management in our hospital was retrospectively analyzed. Results Maternal satisfaction degree was significantly increased, complaints and errors of nursing care were significantly decreased. Conclusions Strengthening of risk management in obstetric care can benefit to eliminate and prevent unsafe factors, so that obstetric care quality is improved.

Objective:To verify the applicability of Dynamic Contrast Enhanced Magnetic Resonance Imaging(DCE-MRI)to evaluate the breast cancer therapy using the high intensity focused uhrasound(HIFU).Methods:Both DCE-MRI and conventional T_1W/T_2W images were acquired for the total 8 subjects.Two consecutive scans were performed for every patient(before operation and 2 weeks after operation)while four were performed for only 2 patients(additional for 6 months and 12 months after operation).The breast cancer therapy by HIFU was assessed hy comparing the changes of signal,the dynamic patterns of time-signal intensity curve,the early-phase contrast enhancement ratios and vessel anatomies around cancer focuses.Results: The shortened T_2 signals were observed in cancer focuses of 5 subjects while 3 still showed longer T_2 values which were differentiated by the high intensity in T_2W images.The early-phase contrast enhancement ratios of those 5 subjects decreased from 60%～80% to

Objective To analyze distribution and drug resistance of MRSA separated,to probe into a treat method for MRSA infection and offer scientific gist for reasonable use of clinical antibiotic. Methods 568 MRSA separated from clinic were measured and a drug sensitivity test was performed by means of Kirby-Bautr agar diffusion method. Results 370 individual plants were filtered, the rate of inspection was 65.1%. MRSA was 36.2 % among them,MRSCON was 77.5% ,the drug resistance of MRSA to quinolones(21% ～48% ) was below MRSCON(84 %～89 % ). The drug resistance of MRSA and MRSCON obviously excelled MSSA and MSSCON ( P＜0.05 ). VRS was undiscovered. Conclusion Severe infection caused by MRS should choose vancomycin resistant enterococci to cure at fist. Staphylococcus was one of primary pathogenic bacterium caused infection in hospital, MRS had multiple drug resistance and measure range about drug resistance should be extended, which would advance the cognition about the drug resistance of antibiotic and cut off the transmitted path, reduce the drug resistance of bacteria and the infection rate in hospital.

Objective:To investigate the effects of soluble factors secreted by MCF-7 breast cancer cells on the differentiation,maturation and function of DCs.Methods:Mononuclear cells were cultured with the culture supernatants from primary MCF-7 cells.Combination of granulocyte-macrophage colony stimulating factor(GM-CSF),interleukin 4(IL-4) and tumor necrosis factor-a(TNF-a) was used to stimulate the cultured mononuclear cells.Then DCs and CTL assays were analyzed.Results:MCF-7 cell supernatant-treated DCs resulted in low expression of CD80,CD83,CD86 and HLA-DR,and the inhibition rate of CTL was 17.35% significantly lower than 56.14% induced by the control DCs(P＜0.01).IL-12 secreted by DCs and IFN-γ produced by PBMNC were all significantly lower than those in the control group (P＜0.01).Conclusion:Experiments in vitro shows that the culture supernatants from MCF-7 breast cancer cells could inhibit the development and functions of DCs.

Objective To compare the diagnostic values of different parameters for neonatal sepsis by observing clinical presentations and laboratory tests of hospitalized newborn infants and to find out the the early and fast way in neonatal sepsis diagnosis. Methods Newborn infants admitted to NICU from Sept.2007 to Feb.2008,who met all inclusion and exclusion criteria,were enrolled.The situations in perinatal period,exact time of the onset of infection,clinical manifestations and laboratory indexes were recorded.Infants were classified into 3 groups:septic group(n=13),nonseptic group(n=12) and noninfectious group(n=12).Sensitivity,specificity,false positive rate,false negative rate,Youden's index and positive and negative predictive values(PPV and NPV) were calculated for each test. Receiver-operating characteristic curves were analyzed to determine the optimal thresholds. Results Among all the clinical manifestations,abnormal reaction had the hightest specificity(84.6%) and accuracy(67.9%) in diagnosing neonatal sepsis.SIRS criteria,with the specificity of 95.8%,was helpful in clinical suspected eases.However,routine laboratory tests,such as WBC,PLT and GLU,had poor sensitivity or specificity;I/T had better specificity(100%),but was subject to discrepancy among different observers.The area under the ROC for CRP and PCT were 0.734 and 0.878,with the optimal threshold of 15 mg/L(P=0.020,Youden's index=45.5%) and 0.81 ng/ml(P-0.000,specificity=100%,Youden's index=75.0%),respectively.Conclusions Careful clinical inspection warrants early detection of sick infants.Evaluation of SIRS criteria in clinical suspected septic infants may help in early diagnosis.WBC,I/T,PLT can be used as routinely monitoring indexes for high risk neonates.CRP and PCT concentrations also have significant diagnostic values.

Attention is being paid to the treatment of hyperopia(presbyopia) with laser thermokeratoplasty.This article mainly presents the theory of laser thermokeratoplasty(LTK),equipment configuration and some key techniques in laser delivery system.

Microscopic polyangiitis (MPA) is an anti-neutrophil cytoplasmic antibody (ANCA) associated systemic small vessel vasculitis and is uncommon in children.Pathologically characterized by paucity immune deposition,fibroid necrosis and crescent formation in glomeruli.MPA is a multi-organ involvement disease.Renal is the mostly involved and commonly manifested as aggressive glomerulonephritis.Lung is the most common involved extrarenal organ.Most MPA patients have positive myeloperoxidase-ANCA and positive perinuclear-ANCA.The onset of MPA is usually obscure,which makes early diagnosis difficult.Detection of ANCA is performed in order to discriminate suspected MPA patients earlier.Confirmed diagnosis relies on pathology.Early standardized treatment is a key factor in prognosis.Standard inductive treatment is currently the combination of corticosteroids with the cytotoxic agent cyclophosphamide.Azathioprine is suggested as the first-choice medication in maintenance therapy.Bio-agents,such as Rituximab,have shown good curative effect both in the inductive treatment and maintenance therapy.

Objective To compare the effects of pre-emptive epidural analgesia and postoperative epiclural analgesia on stress response to upper abdominal surgery. Methods Thirty ASA Ⅰ or Ⅱ patients undergoing elective upper abdominal surgery performed under general anesthesia were randomly divided into 2 groups (n = 15 each): Ⅰ pre-emptive epidural analgesia group (group P) and Ⅱ postoperative epidural analgesia group (group C). A mixture of 0.5 μg/ml sufentanil and 0.15% ropivacaine 250 ml was used for epidural analgesia in both groups. The epidural catheter was placed at T_(10-11) interspace. The epidural regimen included a loading dose of 15 ml followed after 30 min by continuous epidurai infusion at 5 ml/h for 50 h. In group P the epidural analgesia was started at 20 min before skin incision, while in group C after operation when the patients emerged from general anesthesia and were extubated. The depth of general anesthesia was monitored using CSI and maintained at 45-55. Vcnoas blood samples were taken before epidnral catheter was placed (T_0, baseline), at 2 h (T_1) and at 18 h (T_2) after operation for determination the concentrations of ACTH and cortisol (Cor) and C reaction protein (CLIP). Results Blood Cor, ACTH and CRP concentrations were significantly increased after operation as compared with the baseline values at T0 and were significantly lower at T_1 and T_1 in group P than in group C. Conclusion Pre-emptive epidural analgesia can more effectively inhibit stress response than postoperative epidural analgesia to upper abdominal surgery.

Objective To discuss the diagnostic value of procalcitonin and C reactive protein in the acute exacerbation period of chronic obstructive pulmonary disease in elderly patients .Methods Patients ages 75 or more with AECOPD were selected ,and the PCT and CRP in blood serum were detected before treated with antibiotics ,then their sensibility and dependability were analyzed . Results Patients were concluded ,the sensibility for CRP>10 mg/L was 92 .19% ,for PCT>0 .05 ng/mL was 43 .75% ,for PCT>0 .25 ng/mL was 28 .13% .The three groups had statistics difference .Patients were divided into three groups according to PCT lev‐el ,CRP had significant difference in the three groups (P<0 .05):the mean value of CRP in PCT<0 .05 ng/mL group was 42 .86 mg/L ,the mean value of CRP in 0 .05 ng/mL

Objective To study the effect of letrozole plus metformin on infertility of polycystic ovary syndrome(PCOS).Methods According to the digital table,90 patients with infertility of PCOS were randomly divided into the control group(n =45 cases) and the treatment group(n =45 cases).The patients of the control group were treated though clomiphene,while the patients of the treatment group were treated though letrozole plus metformin.The ovulation rate,pregnancy rate,sex hormones and insulin resistance were detected.Results The homeostasis model assessment of insulin resistance index (HOMA-IR) was (5.72 ± 2.37) before treatment and (3.16 ± 1.39) after treatment in the treatment group.HOMA-IR was (5.69 ± 2.40) before treatment and (4.81 ± 2.06) after treatment in the control group.There was a significantly decrease in the treatment group (t =3.7246,P ＜ 0.05).The ovulation rate was 80％ in the treatment group,while 60％ in the control group,the difference between the two groups was significant(x2 =4.06,P ＜0.05).The pregnancy rate was 48.9％ in the treatment group,while 28.9％ in the control group,the difference between the two groups was significant (x2 =5.77,P ＜ 0.05).Conclusion Letrozole plus metformin could promote the ovulation and decrease insulin resistance.